(302) Clean Your Own House First: A Deep Dive Into One PICU’s Health Disparities Using EHR and VPS Data

Introduction: Child health disparities persist in pediatric critical care and are heavily impacted by Social Determinants of Health (SDoH). Utilization of composite Social Determinant of Health (SDoH) metrics such as the Childhood Opportunity Index (COI) may highlight areas for community and health system level mitigation efforts when disparities are identified in individual centers. We hypothesize that individual SDoH including race, ethnicity, insurance status, and census-tract level COI are associated with worse outcomes for PICU patients including mortality, complication rate, and length of stay (LOS).

Methods: We utilized electronic health record and local Virtual Pediatric Systems (VPS) data from the Children’s Hospital New Orleans PICU, to map patient outcomes (mortality, complication rate, PICU and hospital LOS) with individual SDoH (insurance status, race, ethnicity) and census tract level COI. All PICU patients admitted from 7/1/2015 to 3/19/2023 were included. Census tract level COI data were geocoded using a patient’s home address. For mortality and complications, a hierarchical multiple logistic regression was conducted for all admissions. For LOS, a hierarchical multiple linear regression included survivors only. Regression models controlled for all SDoH variables plus age, sex, severity of illness, primary diagnostic category, medical/surgical admission, planned/unplanned admission, and pre/post the COVID-19 pandemic.

Results: A total of 5,831 cases were included, with a mortality rate of 2.9%. Patients with “other” insurance status (self-pay and uninsured) had decreased odds of survival compared to those with government insurance (OR 0.280, 95% CI 0.101-0.773, p=0.014). Black patients had longer PICU LOS (β = .033, 95% CI 0.042-0.974, p=0.033) and hospital LOS (β = 0.054, 95% CI 1.260-4.482, p< 0.001) compared to White patients. COI and ethnicity had no significant association with PICU related outcomes.

Conclusions: In this single center analysis of PICU patients, individual SDoH including insurance status and race, were associated with worse health outcomes including mortality, PICU and hospital LOS. The identified health disparities represent important areas for further investigation and subsequent mitigation efforts and can be replicated by other centers hoping to improve health equity.